differential diagnosis: adhd

Things That Cause ADHD-Like Symptoms

by Robert Needlman, M.D., F.A.A.P.reviewed by Lynn Cates, M.D., F.A.A.P.In diagnosing ADHD, a doctor has to check carefully for other conditions that can imitate ADHD but require very different treatment. As the parent of a child who may have ADHD, you should know about these other possibilities so that you can be alert to signs of them. The following list isn’t complete, but it covers the most common problems that can look like ADHD:

Medications: The most common medical cause of ADHD symptoms is probably medications taken to treat other conditions. Allergy medicines and medicines to treat seizures are well known for causing hyperactive behavior, but many others do, too. You may or may not find this side effect listed on the bottle; when in doubt, check with your child’s doctor or the pharmacist.

Seizures: A particular kind of seizure, called absence seizures or petit mal, causes a child to stare with a blank look for several seconds or even minutes at a time. It looks like the child is daydreaming, when in actuality he is unconscious. He may or may not fall down. These seizures can cause a child to lose track of what’s going on in the classroom and appear inattentive. An EEG test is good at picking up this treatable condition.

Sleep problems: A child who is overtired much of the time may appear to have ADHD. A common cause of overtiredness is obstructive sleep apnea (OSA), a condition that almost always involves snoring. Any child who may have ADHD and who snores needs to be evaluated for OSA.

Vision and hearing deficits: Obviously, a child who can’t see the board or hear the teacher will have trouble paying attention in class. Even partial hearing loss can interfere with the child’s ability to make sense of what he hears, and therefore to pay attention to it. The best way to rule out such possibilities is through formal hearing and vision testing.

Learning disabilities: Children with various types of learning disabilities (LD) often have difficulty staying focused in class. They tend to do much better at home and with friends. LD can mimic ADHD, or the two conditions can coexist. The treatment for LD is not medication, but rather special education.

Too little, or too much, structure: Classrooms and homes that are disorganized, with lots of distractions (such as other children yelling or the TV playing all the time), can make some children act as though they have ADHD. On the other hand, classrooms or homes that are overly structured–requiring a child to sit still for long periods of time without talking, for example–can make a child who simply has an active and spontaneous personality appear to have ADHD.

Anxiety: Children who are anxious all the time–perhaps because there is fighting at home or at school, or because of some other source of stress–often have difficulty paying attention. A family history of anxiety disorders should raise this possibility in any child suspected of having ADHD. Closely related problems include obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). Children who have been abused–either physically, sexually, or emotionally–can have a tough time focusing on particular tasks and controlling their impulses. The medications often used to treat ADHD can make anxiety disorders worse, so the distinction between these conditions is very important.

Depression: Although many adults with depression move less than normal, children who are depressed may be overactive, impulsive, and inattentive–just like children with ADHD. There are also other symptoms that a skilled doctor can find that point toward depression. Because the treatment of this condition is very different from the treatment of ADHD, it’s important for the child’s doctor to consider depression.

10 ADD/ADHD Myths

By Karin A. Bilich

Separate the fact from the fiction!

Many parents are confused about exactly what Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) really are. The first thing you should know is that the two conditions, while slightly different, are now both being referred to in the medical community as ADHD. Here are 10 common myths — and the scientific facts to dispel them — that surround this disorder.

Myth #1: Only kids who are hyper have ADHD.

While hyperactivity is the most common symptom of ADHD, it is possible for a child to be suffering from the disorder without being hyperactive. ADHD actually has three subtypes:

·A predominantly inattentive subtype: Signs include becoming easily distracted by irrelevant sights and sounds; failing to pay attention to details and making careless mistakes; rarely following instructions carefully and completely; losing or forgetting things like toys, pencils, books, and tools needed for a task.·A predominantly hyperactive-impulsive subtype: Signs include feeling restless, fidgeting and squirming; running, climbing, leaving a seat in situations where sitting or quiet behavior is expected; blurting out answers before hearing the entire question; and having difficulty waiting in line or for a turn.·A combined subtype, which is the most common of the three.

Children who fit into only the first subtype may be suffering from ADHD without showing signs of hyperactivity.

Myth #2: Children can outgrow ADHD.

If left untreated, ADHD continues into adulthood. However, by developing their strengths, structuring their environments, and using medication when needed, children with ADHD can grow up to be adults leading very productive lives. In some careers, having a high-energy behavior pattern can be an asset.

Myth #3: Children on ADHD medications are more likely to take drugs as teenagers.

While it’s true that people with ADHD are naturally impulsive and more likely to take risks, those patients taking stimulants for this disorder are actually at lower risk of using other drugs. Children and teenagers who have ADHD and also have coexisting conditions may be at high risk for drug and alcohol abuse, regardless of the medication used.

Myth #4: Ritalin “cures” ADHD.

Ritalin, a psychostimulant medication, is one of the most common forms of treatment for ADHD. It’s been shown to help children focus and be less hyperactive. But in order to be most effective, it must be part of a larger treatment plan that may include academic help for the child and behavior-modification treatment.

Myth #5: Kids with ADHD are just poorly disciplined.

ADHD is a condition of the brain that makes it difficult for children to control their behavior. While researchers have been unable to find the exact cause of ADHD, they have discovered a distinct change in brain size and activity in children with ADHD. Because these children have difficulty controlling their behavior, they may be labeled “bad kids.” This is far from the truth.

Myth #6: Children on Ritalin will never grow to full size.

Ritalin may have an effect on some children’s growth. But recent studies have revealed that any effect on height is only temporary. Even children who are still taking the medicine throughout adolescence ultimately do achieve their normal height.

Myth #7: ADHD can be treated through herbs and vitamins.

You may have heard media reports or seen advertisements for “miracle cures” for ADHD. However, the following methods have not been proven to work in scientific studies:

Research doesn’t support the theory that sugar can cause ADHD. In fact, it’s highly unlikely that sugar intake can affect the size of parts of a child’s brain, as is seen in patients with ADHD.

Myth #9: ADHD isn’t associated with any other conditions.

The majority of children who have been diagnosed with ADHD have at least one coexisting condition. The most common conditions are:

·Conduct disorder: Up to 35 percent of children with ADHD also have oppositional conduct disorder. Children with this condition tend to lose their temper easily and are defiant and hostile toward authority figures. Studies show that this type of coexisting condition is most common among children with the primarily hyperactive/impulsive and combination types of ADHD.·Mood disorders: About 18 percent of children with ADHD also have mood disorders, more frequently among children with inattentive and combined types of ADHD. Children with mood disorders or depression often require a different type of medication than those normally used.·Anxiety disorders: These affect about 25 percent of children with ADHD. Children with anxiety disorders have difficulty functioning because of extreme feelings of fear, worry, or panic, and may frequently suffer from a racing pulse, sweating, diarrhea, and nausea. Counseling and/or medication may be needed to treat these coexisting conditions.·Learning disabilities: Learning disabilities make it difficult for a child to master specific skills, such as reading or math. ADHD is not a learning disability in itself, but it’s a common adjunct to learning disabilities. These two conditions together can make it very difficult for a child to do well in school.

Myth #10: Kids with ADHD won’t amount to anything.

Many famous artists, scientists, and politicians had ADHD as children. Here’s a list of some well-known celebrities with ADHD:

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